365: Ask David: Do Thoughts REALLY Cause Feelings? And More!

Where Do Feelings Come From?

Getting Unstuck from Apathy

Ancient Stoic Philosophers–and More!

Ask David Questions for Today

Bystad: Why is it so helpful to write down your negative thoughts when you’re upset?

Anyinio: Do we have to have a thought every time we have an emotion? What if I see a car coming fast and about to hit me? Would I have to have a fast automatic thought?

Raghav: How can I get unstuck from apathy?

Anita: What are the necessary and sufficient conditions for emotional distress as well as escape from emotional distress?

Louisa: Can you tell us some more about the ancient and modern Stoic philosophers who influenced the development of CBT and TEM-CBT?

Answers to today’s questions. The following answers were written before the podcast. The information on the podcast may be quite different in some cases, and will typically provide much more information than the brief answers below. David


Bystad asks: Why is it so helpful to write down your negative thoughts when you’re upset?

Dear David!

I have practiced the paradoxical approach where I just write down my thougts / worries without challenging them.

I think I learned that approach from your great book «When Panic Attacks».

This is something that really works for me, especially for worries. It is almost like I «get the worries out of my head».

Can you talk about this approach in your lovely podcast, why is it so effective for some people??

Best regards from Martin

David’s reply

Great question. Will address it the next time we record an Ask David podcast!


Anyinio asks: Do you ALWAYS have a thought before you can experience an emotion / feeling?

David’s response

The word “thought” is just a form of shorthand for perception. Perception can take many forms. When you see a car about to hit you, you already HAVE a negative and alarming thought!

If you like, you can check out the railroad track story in my Feeling Good Handbook. It is a story about a man who became euphoric after his car was hit by a train going 60 MPH because of his thoughts about it!

When a deer spots a pack of howling wolves, it runs in terror. It does not have a “thought” in English, but it DOES have the perception of being in imminent danger, and it DOES experience intense, sudden fear. However, the deer did NOT feel fear / anxiety until s/he SAW and correctly interpreted the pack of wolves.

Thanks, best, david


Raghav asks: How can I get unstuck from apathy?

Hi Dr. Burns,

I hope you’re doing well and thank you so much for all of your incredible work! It has really helped me pull myself out of some of the deepest depressions and anxieties I’ve had.

I wanted to ask for your help with a problem I’ve been facing recently:

I seem to get stuck in depressive cycles at times where I don’t want to do a DML even though I know it will make me feel better. When I start doing the positive reframing, it helps melt away this resistance, but I still mope around for a while before I start the positive reframing. My thoughts during this time are generally “There’s no point to getting better,” “Doing a DML is like forcing myself to cheer up,” “I should care about getting better more than I do right now,” and “There’s no meaning to life.” How would you recommend I go about dealing with this apathetic state?

I would greatly appreciate any help in this matter!



David’s reply:

You could perhaps list:

    1. All the really GOOD reasons NOT to do a DML.
    2. What the procrastination / avoidance shows about you and your core values that positive and awesome.
    3. How the avoidance helps you.

Something along those lines.

I might make this an Ask David question if that’s okay with you. Could use your first name only, or a fake name if you prefer.

Thanks! Good question, as so many can relate to it!

Best, david

Raghav’s response to David

Here’s the answers I came up with:

Good Reasons NOT to do a DML

  1. Doing a DML might be difficult and take a long time.
  2. I might not be able to answer some of my thoughts.
  3. Even if I do a DML, I might not be able to change my mood.
  4. Even if I change my mood, there’s no point in being happy.
  5. There’s no sense of meaning in doing a DML.
  6. It feels inauthentic to try to change my mood.
  7. Even if I do a DML now, I will return to this state again.
  8. Doing a DML is like forcing myself to cheer up and I don’t want to be forced to do anything.
  9. I want to be able to get better without doing a DML.
  10. I might have to confront really negative and distressing thoughts.

Core Values it shows about me

  1. I care about doing things successfully — I don’t want to half-ass it.
  2. I want to put my best foot forward when doing tasks — i.e. not do them when I’m tired.
  3. I want to be self-reliant and be able to solve all my problems myself.
  4. I care about being able to change my mood.
  5. I care about having meaning in life.
  6. I care about being authentic to my emotional states — I can honor my apathetic/bored side.
  7. I can sit with my sadness and apathy rather than trying to escape it.
  8. I care about having lasting solutions rather than short-term fixes.
  9. I’m my own man — I’m not going to be forced to do something I don’t want to do.
  10. I care about being able to deal with my emotional problems without “crutches.”

How the Avoidance Helps Me

  1. It means that I don’t have to do the hard work of doing a DML.
  2. I don’t have to engage in the ups and downs of life if I’m apathetic/avoidant.
  3. I can keep engaging in avoidance and distracting myself.
  4. It feels like there are no consequences to my actions so I feel more free.
  5. I don’t have to do the hard work required to build meaning into my life.
  6. I can fully engage and honor my apathy and boredom.
  7. I’ll push myself to search for lasting solutions to my problems.
  8. It pushes me to improve my mental capabilities of solving my problems.
  9. It helps me avoid the pain and anguish of actually addressing really negative thoughts.
  10. It pushes me to find more interesting things to fill my life with.


David’s reply

Great work, thanks! So now my question is this: Given all these positives, it is not clear to me why you’d want to do a DML. What’s your thinking about this?

Best, david


 Anita asks about the necessary and sufficient conditions for emotional distress as well as escape from emotional distress?

Dear David

While revisiting Feeling Great I was thinking further about the interplay of necessary and sufficient conditions that are correlated to emotional distress.

Necessary condition: You must have a negative thought

Sufficient condition: You must believe in the negative thought

I was thinking of another sufficient condition that may account for the behavioural component of emotional distress:

Sufficient condition: You must act in way that reinforces your negative thought.

For me this additional sufficient condition unlocks another philosophical underpinning why exposure is a key to overcoming anxiety.

For example, if I have a negative thought I’m going to screw up in a presentation and then I believe it 100%. I can still summon up the courage to go ahead and do the presentation. Thus, I’m behaving in a way that doesn’t fulfil the second sufficient condition, and therefore another way to reduce emotional distress. More often than not, the presentation is not as calamitous as I anticipated anyways.

Thanks for reading.

Warm Regards


David’s reply

Hi Anita,

Great question, thanks. I greatly appreciate folks who think more deeply about these things.

Exposure is a desirable tool in the treatment of anxiety, for sure, but if you point is “necessary and sufficient” for emotional distress, then the action thing is an unnecessary and erroneous, to my way of thinking, add-on. For example, many people who are severely depressed and believe themselves to be worthless do very little, and others do a great deal, but both feel the same severity of distress.

Could we use this for an Ask David, with or without your first name? If so, we could also discuss the “necessary and sufficient” for emotional change. Here the sufficient condition is that you no longer believe  the negative thought, or your belief has gone down significantly.

You can respond, too, if you like to my comments.

Warmly, david

Anita’s Response to David

Thanks David, sure I’d be pleased if you find any of what I wrote useful for your listeners. Feel free to use my first name. I’m also curious to know more about the depth of belief in a negative thought as a sufficient condition for emotional distress. Is there a particular intensity or tipping point that might lead to the emotional distress?

David’s Response: The greater you belief in a negative thought, the greater the emotional impact. There’s no “tipping point.”

I loved the premise of your book: “When you change the way you think, you can change the way you feel” It got me pondering about the possibility other things such as some behaviours in addition to thoughts that could be associated with emotional distress.

David’s Response: Your own or someone else’s behaviour won’t have any effect on you until you have a thought, or interpretation, of what’s happening. This is the basic premise of CBT, going back 3500 years or more.

An example I’m thinking of is workplace procrastination. Let’s say I have been given two weeks to tackle a laborious project. I might initially have thoughts there is plenty of time and I can procrastinate for the first week doing things I find more satisfying at work.

Towards the end of the second week, panic sets in as I rush through the project so I can still meet the deadline.

After the event, I start ruminating and believing self-critical thoughts such as “I shouldn’t have been so lazy” and “I’m never able to handle projects well.”

Is it to say, the behaviours before the event has little to no bearing on the negative thoughts or belief after the event? And if so why is it really the case that the negative thinking comes into play after the event happens?

David’s Response: Negative thinking can happen before, during, or after an event.

I really have gained much from many of your books. I’m inquiring to deepen and refine my own thought processes.


Warm Regards


David’s Response

Thanks so much for you kind and thoughtful comments.


Louisa asks: I’d like learn more about the ancient and modern Stoic philosophers who influenced the development of CBT and TEM-CBT.

Hello Rhonda and David,

I am a Belgium based listener thoroughly enjoying the podcast and sharing it far and wide! I love the TEAM CBT structured approach.

I find in particular that many of the methods are (relatively) easy to remember and administering self-help feels much easier than I ever imagined.

Well-done, David!

I wonder if David could talk one time about the different influences various figures in the development of CBT right from its inception with (it seems to me) the Roman Stoics until this century.

Some names that come to mind are Seneca, Epictetus, Marcus Aurelius, to Albert Ellis, Aaron Beck & William Glasser (these last three all since passed away.)

Are they any particular names that stick out as having been particularly useful in the development of TEAM CBT and why or how? Do the Roman Stoics still have anything to offer us?

Thanks for the great show!


David’s Response

Hi Louisa,

Thanks, will include in the list of questions for the next Ask David, depending on time constraints.  Best, david

PS Albert Ellis documents much of the history in his book, Reason and Emotion in Psychotherapy. I believe that Karen Horney, the feminist psychiatrist of the first part of the 20 th century, discuss lots of the current ideas as well, especial the “need” for love, success, etc. and the idea that we have an “ideal” self and a “real” self. We get upset when we realize that the two don’t match!

David and Rhonda are grateful that Matt can join us often on the podcast. We are both members of the Matt May fan club and believe he is one of the finest therapists on planet earth. He is a board-certified, Stanford-trained psychiatrist and expert in TEAM-CBT. You can contact him at:

Dr. Rhonda Barovsky is a Level 5 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. You can reach her at

You can reach Dr. Burns at

This is the cover of my new book, Feeling Great.
It’s on sale right now on Amazon, and it’s ridiculously cheap!
The kindle and audio versions are available now too! Check it out!


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